Migraines Flashcards

1
Q

Epidemiology of migraines

A

3 times more common in women

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2
Q

Common triggers for a migraine attack

A

tiredness, stress
alcohol
combined oral contraceptive pill
lack of food or dehydration
cheese, chocolate, red wines, citrus fruits
menstruation
bright lights

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3
Q

Migraine diagnostic criteria

A

At least 5 attacks fulfilling criteria B-D

  • Headache attacks lasting 4-72 hours*

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Headache has at least two of the following characteristics:

  1. unilateral location
    in children, attacks may be shorter-lasting, headache is more commonly bilateral, and gastrointestinal disturbance is more prominent.
  2. pulsating quality (i.e., varying with the heartbeat)
  3. moderate or severe pain intensity
  4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)

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During headache at least one of the following:
1. nausea and/or vomiting*
2. photophobia and phonophobia

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Not attributed to another disorder

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4
Q

X

A
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5
Q

X

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6
Q

X

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7
Q

X

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8
Q

X

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9
Q

X

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10
Q

X

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11
Q

X

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12
Q

C

A
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13
Q

X

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14
Q

C

A
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15
Q

X

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16
Q

X

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17
Q

X

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25
Hemiplegic migraine characteristic
motor weakness is a manifestation of aura in at least some attacks
26
Risk factors for hemiplegic migraines a
a strong family history
27
migraine with brainstem aura (basilar-type migraine, or Bickerstaff's Syndrome)
gradual onset over ten minutes, and step-wise progression of symptoms point Dysarthria Vertigo Diplopia Temporary decreased consciousness - syncope Pins and needles of both arms
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34
ACUTE Migraine management attacks ?
oral triptan and an NSAID, or an oral triptan and paracetamol oung people aged 12-17 years consider a nasal triptan
35
if first line management not effective ?
NON oral preparation of metoclopramide or prochlorperazine a non-oral NSAID or triptan
36
x
37
what is used as a migraine prophylaxis ?
propranolol topiramate - avoided in pregnancy / can reduce the effectiveness of hormonal contraceptives amitriptyline
38
if first line managing of migraine prophylaxis fail ?
10 sessions of acupuncture over 5-8 weeks riboflavin (400 mg once a day)
39
migrane pophylaxis women with predictable menstrual migraine
frovatriptan (2.5 mg twice a day) or zolmitriptan (2.5 mg twice or three times a day) as a type of 'mini-prophylaxis'
40
Migraine during pregnancy first line ?
paracetamol 1g is first-line NSAIDs can be used second-line in the first and second trimester
41
what is needed to be avoided in pregnancy ?
avoid aspirin and opioids such as codeine during pregnancy
42
if patients have migraine with aura what is contraindicated ?
combined oral contraceptive (COC) pill - increase risk of stroke
43
hormone replacement therapy (HRT) safe to prescribe fro migraines ?
hormone replacement therapy (HRT)
44
migraine with menstruation ?
mefanamic acid or a combination of aspirin, paracetamol and caffeine